Directions in Behavioral Medicine J. Thomas Dalby, Ph.D. The escalating involvement of psycholo- sists in health care can be seen in the prolif. tration of new professional societies, jour- nals, books and credentialing agencies. Be- havioral medicine is the contemporary label {or the movement which has been described ‘as "that broad interdisciplinary field of scient- fic inquiry, education, and practice which ‘concerns itself with health and ilness or rlat- ‘ed dysfunction” (Matarazzo, 1960). The Yale Conference on Behavioral Medicine in 1977 \was the first attempt to formaly delineate the ‘scope of behavioral medicine and the eventu- ‘al definition agreed upon was: .. the inter- ‘dscipinary field concerned with the develop- ‘ment and integration of behavioral and bio- ‘medical science, knowledge and techniques. relevant to health and ilness and the applica tion of these techniques to prevention, diag: ross, treatment and rehabiltation” (Schwartz & Weiss, 1978). Unfortunately, these defini tions have generated disagreement on what should or should not be subsumed under the rubric “behavioral medicine” or indeed if the ‘term is necessary at al. Schwartz and Weiss (1977, 1978) have argued, however, that be- ‘havoral medicine represents a change in dt- ‘ection from older fields such as psychosome tic medicine’ 1. The field of psychosomatic medicine evolved primarily from the biomedical sci- ences and was based on psychoanalytic theories. Behavioral medicine has evolved from the behavioral sciences with emphe- sis on learning theories, physiological, so- ial and clinical psychology. 2. Psychosomatic medicine has emphasized etiology and pathogenesis of physical dis: ease. Behavioral medicine has tended 10 be more directly concerned with behav- ioral approaches to the treatment and pre- vention of physical disease. 3. Behavioral medicine eliminates the implied mind/body dualism in "psychosomatic medicine”. 4, Behavioral medicine involves direct inter- ‘action of biomedical and behavioral sci- fence, with psychiatry as a coequal partic- pant rather than as a mediator as with psy: ‘chosomatic medicine. Definitions aside, @ rationale for the con- tinued development of behavioral medicine is relatively straightforward. Mortality rates in western societies are no longer dominated by infectious diseases lke tuberculosis but by chronic disorders such as heart disease. To ilustrate this point, the folowing isa list in descending order of the ten leading causes. Cf death in American males between the ages > of 36 and 54: heart disease, cancer, acci- dents, cithosis ofthe liver, suicide, cerebro- vascular diseases, homocide, pneumonia/in- fivenza, diabetes, emphysema (Vital Statis- ties of the United States, 1977). The behav- ioral components of these disorders isso im- pressive that Stachnik (1980) has concluded that "the most serious medical problems that today plague the majority of Americans ere ‘not ukimately medical problems at all; they are behavior problems, requiring the altera- tion of characteristic response patterns, and thus fall squarely within the province of psy- chology”. Disorders ofa biopsychosocial na ture are not becoming prominent simply be- cause infectious diseases are being iradicat {ed but because they themselves are becom. ing more widespread. For example, the lead: ing cause of early adult death, heart disease, was relatively rare inthe United States in the early 20th century (Stamler, 1967) but now ‘accounts for half ofall deaths. Other ifestyle ‘diseases” of particular concern to health care psychologists are stress-related disord- rs (Levi, 1960), headaches (Bakal, 1975) and ‘other pain, and appetiive disorders. Despite the obvious need and potential for 2 field such as behavioral medicine the rela- tive commitment by the discipline of psy- chology has been small. Ahough behavior- ‘al medicine has been described as an inter: disciplinary field including psychiatry, socio: logy. epidemiology, anthropology, health economics and biostatistics, ts psychology that has the longest history and is the most comprehensive science of human behavior. The APA Task Force on Health Research (1976) stated that “there is probably no spe- Cialty field within psychology that cannot contribute to the discovery of Behavioral var ‘ables crucial to a full understanding of sus- ceptbilty to physical illness, adaptation to such illness, and prophyatically motivated behaviors”. This statement reinforces the notion that behavioral medicine will not be just a subinterest of clinical psychology but will benefit from the involvement of social and personality psychologists, development- al psychologists, and the full spectrum of ex: perimental psychologists. At a time when ‘academic opportunities for young psycholo: ists is extremely limited, the field of behav- iofal medicine should present chances limit ed only by imagination and resourcefulness. The involvement of non-clinical specialists may help to overcome perhaps the most dif- ficult obstacle to the full development of be- havioral medicine—the perception by psy: chologists that mental heath isthe sole r sponsibiity of applied psychology. The in- clusion of physical health concerns should not detract from the study and treatment of ‘mental health for indeed any comprehensive ‘model of health and illness should include both of these components. The problem is that we feel comfortable and accepted as. ‘mental health professionals but rather awk- ward in the role of physical health care spe- Cialists. We can hardly expect the public at large to ater their atitudes towards psychol- ‘ogists in medicine until we do ourselves. Luckily, the roles for psychologists in be- hhavioral medicine are not clearly defined leaving us with considerable freedom to ex- plore different applications. Health educa- tion is an obvious area for leaming specialists to develop since there is a “laughable state ‘of hhealth education in our public schools, where there is often no program at allo else is comprised of what the gym teacher does with the class for fory minutes on @ rainy {day in the spring” (Stachnik, 1980). Given the amount of time spent by children in ‘school, consistent education and reintorce- ‘ment of health behavior may go a long way in reducing itestyle “diseases”. Wil behavioral practitioners and research- ‘ers be accepted in health care by practicing physicians? There is ample evidence that phy- Sicians recognize the value of behavioral sci ence in medicine (Holmes, Donald & Gold schmidt, 1978) and that a substantial propor- tion of their practices involve psychosocial problems (Brockway, 1978). While medical ‘education has significantly increased the ‘amount of behavior science in its curriculum there is stil no organized integration of psy- chology and medicine in applied practice. Within the interdisciplinary confines of be: havioral medicine perhaps this will occur. Physicians will not only find the support they ‘need in dealing with behavioral problems but may also find that the effectiveness of their ‘medical treatments will increase. For exam ple, 20.80% of patients make errors in taking their medications, and 25-60% stop taking ‘their medications tong before itis therapeu: tically desirable to do so (Dunbar and Stun kard, 1978). Behavioral strategies to correct these major problems in medical treatment have shown potential. Most psychologists involved in behavioral ‘medicine today lack formal taining as such ‘and have entered the field through ad hoc it teinship experionces. There are now more ‘Support forthe wnting of ths article wos provided by the National Health Research and Development Programme, Health and Welfore, Canada Dr: Daby''s a Dplomate of the Amercan Academy of Behavioral Medsine and Is ised inthe Natonal Reger af Heath Sewice Provtlers in Psychology Alberta Psychologist Vol.11'No,2, Apel 19827formal research and applied training pro- ‘grams in behavioral medicine (Weiss, 1860, Matarazzo, 1980; Faust, Uli, and Thurber, 1880). A sampling of these programs shows ‘8 wide diversity of psychological and medical Content. The published work in the area of behavioral medicine, especially with adults, however shows a decided bias for behavior ‘modification applications. These methods ‘are very useful in treating health care prob lems, but hopefully behavioral medicine wil ‘mature into more than just behavior modi ‘ation of health disorders. The emerging field of behavioral medicine presents an exciting challenge for psycholo- ‘ists. We should, however, refrain from over. statements about what we can do in health care. Our credibility wil be established if we ‘set modest goals and meet them. Psycholo. SY is justified in raising health care on its list Of priorities, both for the vitality ofthe disc pine and the society in which it functions. References APA Task force on Heath Research. Contibu tions of psychology to health research Pet tems, problems and potentials. American Psy. chologise, 1876, 31, 263274 Bokal, D.A. Headache: A bopsychological pe ‘spective. Psychologica! Buletin, 1S7S: 62, 95S. E Brockway, B.S. 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Psychosomote Medicine, 197), 37781 Schwartz, G.E. and Weiss, S.M Behavioral medi ‘he revised: An amended definition, Journal of Behavioral Medicine, 1978, 1, 249-253 Stachnik, TJ. Portis for paychology in medical ‘shucslon and heath ete ive. Amercan Paychologist 1980, 35, 8 15. Stamler, J. Lectues’on preventative cardiology, New York: Grune and Stratton, 1967, Weiss, S°M. Behavioral medicine In the United States: Research, clnical and ‘waning oppor unites. ternation Journal of Menta eat H880, 917-2, 12196, 7 8 AbertaPsychologst Vol 11 No. 2, Apri 1962 Major Sources in Behavioral Medicine J. Thomas Dalby, Ph.D. ‘Some Recent Behavioral Medicine Texts Pinkerton, S.S., Hughes, H., and Wen- rich, W.W. Behavioral Medicine: Clinical Applications, New York, Wiley- Interscience, 1961 Doleys, D.M. Meredith, F.L., and Ciminero, AAR. (Eds.) Behavioral Medicine: Assess: ‘ment and Treatment Strategies. New York, Plenum Press, 1982 Wiliams, 8.J., Foreyt, J.P., and Goodtick, G.k. (Eds.) Pediatric Behavioral Medicine, New York: Praeger Publishers, 1981 Haynes, S.N., and Gannon, L. (Eds.) Psy- chosomatic Disorders: Approach to Etiolo- Y and Treatment. New York: Praeger Publishers, 1981 Melomed, 8.G., and Siegel, LJ. Behavioral ‘Medicine: Practical Applications in Health Care. New York: Springer, 1980, Rachman, S. Contrbutions to Medical Psy- ‘chology: Volume 2. New York: Pergamon Press, 1961 Prokop, C.K., and Bradley, L.A. (Eds.) Med- ‘kal Psychology: Contributions to Behav. ‘oral Medicine. New York: Academic Press, 1981 Weiss, S.M., Herd, J.A., and Fox, B.H. {Eds.) Perspectives on ‘Behavioral Medi ine. New York: Academic Press, 1981 Societies ‘American Academy of Behavioral Medicine 18616 Northwest Plaza Drive ‘Suite 210 Dolls, Texas 75225, U.S.A, Society of Behavioral Medicine {600 North Wolfe Street Box 450 Bakimore, MD 21205, U.S.A. Society of Pediatric Psychology Georgette Psarras Children’s Hospital 281 Locust Street ‘Akron, Ohio 44308, U.S.A, Biofeedback Society of America 4301 Owens Street - Wheatridge, CO 80033, U.S.A. Behavioral Medicine Journals Journal of Behavioral Medicine Journal of Pediatric Psychology Plenum Publishing Corporation 233 Spring Street New York, N.Y. 10013, U.S.A. Journal of Health and Social Behavior ‘American Sociological Association 1722. Street NW. Washington, D.C. 20036, U.S.A, The Britsh Joumal of Medical Psychology ‘The British Psychological Society St. Andrews House 48 Princess Road East Letcester, LEI7DR, U.K. Psychological Medicine Cambridge University Press 2 East B7th Street New York, N.Y, Health Psychology Lawrence Erlbaum Associates, Inc. 365 Broadway, Dept. AP Hillsdale, N.Y. 07642, U.S.A. Journal of Human Stress Rural Route 1, Box 296 Shelburne Falls, MA 01370, U.S.A. Psychosomatic Medicine Elsevier North Holland, Inc. 52 Vanderbit Avenue Now York, N.Y. 10017, U.S.A. ournal of Psychosomatic Research Pergamon Press, inc. ‘Maxwell House, Fairview Park 10022, U.S.A, Elmsford, N.Y." 10523, U.S.A. . -Jourrelof Deveopmentand Behavioral Pedatrcs The Wiliams and Wilkins Company 428 East Preston Street Botimore, MD21202, U.S.A. . SEMINAR ON DEPRESSION Theories, Etiology and Treatment Strategies Presentations by psychiatrists, psycholo {ists and social workers. Date: Saturday, May 8, 1982 Time: 9:00 a.m. to 4 p.m, Place: Terrace Inn, Edmonton Cost: $25 For more information, codtact: Donald C. Fair, Ph.0. Suite 204, 10816 - 82 Avenue Edmonton, Alberta T6E 283 Phone: (403) 439.1143 Sponsored By The Special Interest Group 6f Clinical and Counseling Psychologists